Prevalence and Correlates of Minor Depression in Type 2 Diabetes

2 型糖尿病患者轻度抑郁的患病率及其相关性

• 批准号: 8323965
• 负责人: SHERITA HILL GOLDEN
• 金额: $ 20.3万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-08-15 至 2014-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8323965
• 关键词: Adjustment Disorders; Adrenal Gland Hyperfunction; Adult; Behavioral; Biological Factors; Blood Pressure; Body mass index; Clinic; Clinical; Complications of Diabetes Mellitus; Coupled; DSM-IV; Data; Depressed mood; Depressive Syndromes; Depressive disorder; Dexamethasone; Diabetes Mellitus; Diagnosis; Diagnostic; Diagnostic and Statistical Manual; Disease; Dyslipidemias; Energy Intake; Epidemiologic Studies; Frequencies; Glycosylated Hemoglobin; Glycosylated hemoglobin A; Health; Health behavior; High Density Lipoprotein Cholesterol; High Prevalence; Hormonal; Hydrocortisone; Hypotension; Individual; Insulin Resistance; Interview; LDL Cholesterol Lipoproteins; Major Depressive Disorder; Mental Depression; Metabolic; Metabolic Control; Non-Insulin-Dependent Diabetes Mellitus; Obesity; Outcome Measure; Participant; Patient Self-Report; Patients; Positioning Attribute; Prevalence; Problem Solving; Questionnaires; Research; Risk; Sampling; Screening procedure; Secondary to; Smoking; Specific qualifier value; Structure; Text; Triglycerides; Visceral; base; depressive symptoms; dexamethasone suppression test; diabetic; disorder control; glycemic control; hypothalamic-pituitary-adrenal axis; macrovascular disease; medication compliance; meetings; mind control; minor depressive disorder; mortality; public health relevance; secondary outcome; waist circumference; Adjustment Disorders; Adrenal Gland Hyperfunction; Adult; Behavioral; Biological Factors; Blood Pressure; Body mass index; Clinic; Clinical; Complications of Diabetes Mellitus; Coupled; DSM-IV; Data; Depressed mood; Depressive Syndromes; Depressive disorder; Dexamethasone; Diabetes Mellitus; Diagnosis; Diagnostic; Diagnostic and Statistical Manual; Disease; Dyslipidemias; Energy Intake; Epidemiologic Studies; Frequencies; Glycosylated Hemoglobin; Glycosylated hemoglobin A; Health; Health behavior; High Density Lipoprotein Cholesterol; High Prevalence; Hormonal; Hydrocortisone; Hypotension; Individual; Insulin Resistance; Interview; LDL Cholesterol Lipoproteins; Major Depressive Disorder; Mental Depression; Metabolic; Metabolic Control; Non-Insulin-Dependent Diabetes Mellitus; Obesity; Outcome Measure; Participant; Patient Self-Report; Patients; Positioning Attribute; Prevalence; Problem Solving; Questionnaires; Research; Risk; Sampling; Screening procedure; Secondary to; Smoking; Specific qualifier value; Structure; Text; Triglycerides; Visceral; base; depressive symptoms; dexamethasone suppression test; diabetic; disorder control; glycemic control; hypothalamic-pituitary-adrenal axis; macrovascular disease; medication compliance; meetings; mind control; minor depressive disorder; mortality; public health relevance; secondary outcome; waist circumference

DESCRIPTION (provided by applicant): Major depressive disorder (MDD) is cross-sectionally and longitudinally associated with risk of type 2 diabetes (T2DM), as well as with an increased risk of micro- and macrovascular complications, worse metabolic control, and all-cause mortality. There is less evidence about similar associations between minor depression (MinD), the focus of this application, and T2DM or its secondary complications. We hypothesize that MinD, based on Diagnostic and Statistical Manual-IV-Text Revised (DSM-IV-TR) criteria, among adults with T2DM is prevalent and is associated with poor metabolic control, as is seen in MDD, and that this association might be explained by behavioral and biological factors associated with these disorders (i.e., poor health behaviors, impaired problem solving ability, and subclinical hypercortisolism). To preliminarily examine this hypothesis, our study has the following specific aims: 1) To estimate the prevalence of MinD in a clinic-based sample of adults with T2DM and compare it to the prevalence of MDD. 2) To compare glycemic control, assessed by glycated hemoglobin (HbA1c), between diabetic individuals with MinD and diabetic individuals with a) MDD or b) no depression. Secondary outcome measures of metabolic control will include LDL-cholesterol, HDL-cholesterol, triglycerides, body-mass index, waist circumference, blood pressure, and presence of diabetic complications. Our secondary aim will be to examine behavioral and hormonal factors that might explain the association between MinD and glycemic control among individuals with T2DM. To accomplish these aims, we propose to screen a clinical sample of up to 750 adults (250/year) with T2DM for depressive symptoms using the Patient Health Questionnaire-2 (PHQ-2) to identify 100 individuals who screen positive for a depressive disorder. We will perform a structured diagnostic psychiatric interview on these 100 individuals, which will enable us to differentiate MinD from MDD and other milder depressive disorders using DSM-IV-TR criteria. We will also perform a structured diagnostic interview on a random sample of 50 controls who screen negative on the PHQ-2 to adjust our prevalence estimates for screening biases on the PHQ-2. We will assess behavioral factors (diabetes-related health behaviors and problem-solving ability) in all participants and will assess subclinical hypercortisolism, using a dexamethasone suppression test, in all 100 subjects who screen positive on the PHQ-2 and in 50 random controls who screen negative on the PHQ-2. This preliminary study will be one of the first to establish the crude prevalence of MinD as a distinct disorder in a clinic-based sample and using a structured diagnostic interview. PUBLIC HEALTH RELEVANCE: We will screen a clinical sample of up to 750 adults (250/year) with type 2 diabetes for depressive symptoms using a questionnaire to identify 100 individuals who screen positive for a depressive disorder. We will perform a structured diagnostic psychiatric interview on these 100 individuals plus a random sample of 50 individuals who screen negative, which will enable us to estimate the frequency (prevalence) of minor depression, a milder depressive disorder, and distinguish it from major depression. We will compare metabolic control of diabetes between those with minor depression and those with 1) major depression and 2) no depression and explore whether behavioral and hormonal factors might explain the association.

描述（由申请人提供）：重度抑郁症（MDD）在横截面和纵向上与2型糖尿病风险（T2DM）以及微血管并发症，代谢控制较差和全因死亡率的风险增加。关于轻微抑郁症（思维），本应用的重点与T2DM或其次要并发症之间类似关联的证据较少。我们假设基于诊断性和统计手册IV-TEXT修订（DSM-IV-TR）标准，在具有T2DM的成年人中很普遍，并且与MDD中的代谢性较差相关，如MDD所示，这种关联可能与这些疾病相关的行为和生物学因素（即，不良的健康行为）可以解释。超皮质醇）。为了初步研究这一假设，我们的研究具有以下具体目的：1）在具有T2DM的成年人的基于诊所的成年人样本中估计心灵的流行，并将其与MDD的患病率进行比较。 2）比较通过糖化血红蛋白（HBA1C）评估的血糖控制，在具有心理和糖尿病患者A）MDD或B）无抑郁症的糖尿病患者之间进行了比较。代谢控制的次要结局度量将包括LDL-胆固醇，HDL-胆固醇，甘油三酸酯，身体质量指数，腰围，血压以及糖尿病并发症的存在。我们的次要目的是检查行为和激素因素，这些因素可能解释了T2DM个体之间思维与血糖控制之间的关联。为了实现这些目标，我们建议使用患者健康调查表2（PHQ-2）筛选最多750名成年人（250/年）的抑郁症状样本（250/年），以识别100名因抑郁症阳性的人。我们将对这100个人进行结构化的诊断精神病访谈，这将使我们能够使用DSM-IV-TR标准将MID与MDD和其他温和的抑郁症分开。我们还将对50个对照的随机样本进行结构化诊断访谈，这些对照对PHQ-2的筛选为阴性，以调整我们对PHQ-2筛查偏见的患病率估计。我们将在所有参与者中评估所有参与者的行为因素（与糖尿病相关的健康行为和解决问题的能力），并将使用地塞米松抑制测试评估亚临床高皮层溶质，在所有对PHQ-2呈阳性的受试者中，以及50个随机对照在PHQ-2上筛选负PHQ-2的受试者。这项初步研究将是最早在基于诊所的样本并使用结构化诊断访谈中确立精神疾病作为独特疾病的原始疾病的一项研究之一。 公共卫生相关性：我们将使用问卷调查表鉴定100名对抑郁症呈阳性阳性的人，筛选出多达750名成年人（250/年）的临床样本（250/年），用于抑郁症状。我们将对这100个人进行结构化的诊断精神访谈，以及一个筛查阴性的50个个体的随机样本，这将使我们能够估计轻度抑郁症的频率（患病率），较轻的抑郁症，并将其与大抑郁症区分开。我们将比较抑郁症和1）严重抑郁症和2）不抑郁症患者之间对糖尿病的代谢控制，并探讨行为和荷尔蒙因素是否可以解释这种关联。